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  1. 1. Date: 18-06-2013By : Saleh BakarTaishan Medical University.Saleh.malik007@gmail.comSubject : Arthopedics
  3. 3. Thoracic Trauma1. Chest trauma (or thoracic trauma) is aserious injury of the chest.2. Thoracic trauma is a common cause ofsignificant disability and mortality, theleading cause of death from physicaltrauma after head and spinal cordinjury
  4. 4. 3. . Blunt thoracic injuries are theprimary or a contributing cause ofabout a quarter of all trauma-relateddeaths. The mortality rate is about1600.Chest injuries were firstdescribed in detail in around 1600 BCin Ancient Egypt.
  5. 5. ClassificationsClassificationsChest trauma can be classified as blunt orpenetrating. Blunt and penetrating injurieshave different pathophysiologies and clinicalcourses.Specific types of chest trauma include:1.Injuries to the chest wall2.Pulmonary Injury3.Airway Injury4. Cardiac Injury5.Blood Vessel Injury
  6. 6. Deteils…Deteils…Injuries to the chest wallChest wall contusions or hematomas.Rib fracturesFlail chestSternal fracturesFractures of the shoulder girdle
  7. 7. Pulmonary InjuriesPulmonary InjuriesPulmonary lacerationPneumothoraxHemothoraxHemopneumothorax
  8. 8. Cardiac InjuryCardiac InjuryPericardial tamponadeMyocardial contusionTraumatic arrestBLOOD VESSEL INJURYTraumatic aortic rupture, thoracicaorta injury, aortic dissection
  9. 9. DaignosisDaignosisMost blunt injuries are managed withrelatively simple interventions liketracheal intubation and mechanicalventilation and chest tube insertion.Diagnosis of blunt injuries may be moredifficult and require additionalinvestigations such as CT scanning.
  10. 10. DaignosisPenetrating injuries often require surgery, andcomplex investigations are usually notneeded to come to a diagnosis. Patientswith penetrating trauma may deterioraterapidly, but may also recover much fasterthan patients with blunt injury.
  11. 11. RIB FRACTUREA rib fracture is a break or fracture in one or more of the bones making upthe rib cage. The first rib is rarely fractured because of its protected positionbehind the clavicle (collarbone). However, if it is broken, serious damage canoccur to the brachial plexus of nerves and the subclavian vessels. Fracturesof the first and second ribs may be more likely to be associated with headand facial injuries than other rib fracturesThe middle ribs are the ones most commonly fractured. Fractures usually occurfrom direct blows or from indirect crushing injuries. The weakest part of arib is just anterior to its angle, but a fracture can occur anywhere. The mostcommonly fractured ribs are the 7th and 10th.[1] A lower rib fracture has thecomplication of potentially injuring the diaphragm, which could result in adiaphragmatic hernia. Rib fractures are usually quite painful because the ribshave to move to allow for breathing. When several ribs are broken in severalplaces a flail chest results, and the detached bone sections will move separatelyfrom the rest of the chest.
  12. 12. A rib fracture is a break or fracture in one or more of thebones making up the rib cage. The first rib is rarelyfractured because of its protected position behind theclavicle (collarbone). However, if it is broken, seriousdamage can occur to the brachial plexus of nerves and thesubclavian vessels..Fractures of the first and second ribs may be more likely tobe associated with head and facial injuries than other ribfractures.[1] The middle ribs are the ones most commonlyfractured. Fractures usually occur from direct blows orfrom indirect crushing injuries..
  13. 13. • The weakest part of a rib is just anterior to its angle,but a fracture can occur anywhere. The mostcommonly fractured ribs are the 7th and 10th.[1] Alower rib fracture has the complication of potentiallyinjuring the diaphragm, which could result in adiaphragmatic hernia. Rib fractures are usually quitepainful because the ribs have to move to allow forbreathing. When several ribs are broken in severalplaces a flail chest results, and the detached bonesections will move separately from the rest of thechest.
  14. 14. CausesRib fractures can occur without direct traumaand have been reported after sustainedcoughing and in various sports – forexample, rowing, karting and golf – often inelite athletes. They can also occur as aconsequence of diseases such as canceror infections (pathological fracture)..
  15. 15. CausesFragility fractures of ribs can occur due to diseased bonestructure, e.g. osteoporosis and metastatic deposits–    
  16. 16. Daignosis• Broken ribs are often indicated by the following symptoms:•  Pain when breathing or with movement•  A portion of the chest wall moving separately from the rest of the chest (flail chest)•  A grating sound with breathing or movement•  Where the mechanism of injury would indicate substantial force to the ribs…
  17. 17. DaignosisBecause children have more flexiblechest walls than adults do, their ribs aremore likely to bend than to break;therefore the presence of rib fractures inchildren is evidence of a significantamount of force and may indicatesevere thoracic injuries such aspulmonary contusion.[1] Rib fracturesare also a sign of more serious injury inelderly people
  18. 18. Treatment• There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Adequate analgesia can avoid this.•  • Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera
  19. 19. HAEMOTHORAX• Accumulation of blood in Pleural cavity is Accumulation of blood in Pleural cavity is called Haemothorax..called Haemothorax..
  20. 20. CausesIts cause is usually traumatic, from a blunt or Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in penetrating injury to the thorax, resulting in a rupture of the serous membrane either a rupture of the serous membrane either lining the thorax or covering the lungs. This lining the thorax or covering the lungs. This rupture allows blood to spill into the pleural rupture allows blood to spill into the pleural space, space, 
  21. 21. Causes• equalizing the pressures between it and the lungs. Blood loss may be massive in people with these conditions, as each side of the thorax can hold 30–40% of a persons blood volume. Even minor injury to the chest wall can lead to significant hemothorax.[1]
  22. 22. Signs and Symptoms• Tachypnea• Dyspnea• Cyanosis• Decreased or absent breath sounds on affected side• Tracheal deviation to unaffected side• Dull resonance on percussion• Unequal chest rise• Tachycardia• Hypotension• Pale, cool, clammy skin• Possibly subcutaneous emphysema• Narrowing pulse pressure
  23. 23. Management• A hemothorax is managed by removingthe source of bleeding and by draining theblood already in the thoracic cavity. Bloodin the cavity can be removed by insertinga drain (chest tube) in a procedure calleda tube thoracostomy.
  24. 24. Management• As the blood thickens, it can clot in the pleuralspace (leading to a retained hemothorax) orwithin the chest tube, leading to chest tubeclogging or occlusion. Chest tube clogging orocclusion can lead to worse outcomes as itprevents adequate drainage of the pleuralspace, contributing to the problem of retainedhemothorax. In this case, patients can behypoxic, short of breath, or in some cases, theretained hemothorax can become infected(empyema). Therefore adequately functioningchest tubes are essential in the setting of ahemothorax treated with a chest tube.
  25. 25. Saleh BakarThanks to All…